Automating the assessment of door-to-imaging time in stroke management using a clinical data warehouse

Assessment of quality and safety indicators (QSI) remains often based on time-consuming manual Electronic Health Record (EHR) review. Through a pilot study in stroke management, we investigated the feasibility of automating the calculation of one French national QSI, the measure of door-to-imaging time (DTI time) i.e. the time interval between the arrival at hospital and the first stroke diagnostic imaging, in a Clinical Data Warehouse (CDW) through a retrospective observational study of patients hospitalized in the Greater Paris University Hospitals (AP-HP) for an acute stroke in 2022. We automatically computed DTI time for more than 6,000 medical records in the CDW using a systematic approach, and validated this method by matching results against the manual AP-HP EHR review from the 2022 French national QSI audit. On this Study population, CDW and manual EHR review methods agreeed on estimating overall indicators, but showed discrepancies in the case-by-case analysis mainly because of human variability both in EHR completion and manual reviewing. Automation looks promising in a context of limited professional resources but requires structured and validated data, interoperability in the case of inter-institutional stays and validly measurable QSI.